tips for drawing blood on obese patients

They may be in a confused, agitated, or combative state of mind. Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. No matter how a patient looks like, it is necessary for a medical professional to protect himself. The number of samples or volume of blood needed will tell you which size syringe to use. Unfortunately, some veins are significantly easier to see than others. link to Blood Test Vs Blood Donation (Comparisons), link to No More Blood Tests For Marriage License. Doctors have access to deep veins like the femoral and subclavian vein that other phlebotomists dont have. The needle may have pulled out of the vein. qG@OWdeDHj5b$Ze+QPbk8oo9uDP+GJXU'X96B@;"p4-BBR'@;Z6U`[VTk^9@(} f4qa l8pE2xr/4A-\1~},HZU!6)QH` T@C 6y@ Eh7| c"qnN n Qf3NQA(d2=d9 yN|1*XYa28YSIkefHIly `zhMs\\U@>fU^s,'/ksc>M# /jD/[7=6e*6c\u1_UL3Rll5nd;m,&!w{,`YNk 3 ]^]u>mrA- k`JM4>!Aoa0z't@l"4vl~"Frq}}]#)V1Z/8BnMs^|^x}^%0)&f3FY8I'wU\`Osd{z_b|{Q30Sck-BT[@'hJV2y )lw[;w]p39=%=N|=}|60m2}Edt/#2x!Ta}$n8x4py}` lt endstream endobj 202 0 obj <>stream If you are drawing from a leg, the extremity needs to be placed over the bed so First, remember where to look. Gravity alone will help reveal veins that were not visible or palpable earlier. Commonly referred to as the antecubital or the AC it can be found in the crevice of the elbow between the median cephalic and the median basilic vein. Venipuncture or drawing blood is one of the most common procedures performed in any medical center. Create well-written care plans that meets your patient's health goals. By submitting this form, I authorize and agree that a representative of Carrington College can contact me about educational services and future offers by email, phone and/or text messaging at the email and telephone number provided above using an automated telephone dialing system, and/or an artificial or pre-recorded voice or text message. Do not apply the tourniquet too tightly over the arm or wrist as it could cause injury or collapse the vein. Re: the 2 tourniquet trick (above and below). We'll need to know about all prescription and over-the-counter medications you're taking. The three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. The needle has passed through the vein. If necessary, apply the tourniquet and examine the median cubital, cephalic, and basilic veins. This, in turn, can cause increases in your blood pressure. Sometimes you won't be able to see the veins at all, but you will be able to palpate them. While holding patients arm, make sure that your finger is well above the insertion point. Anchor the vein from below with your non-dominant hand by gently pulling on the skin distal to the insertion site. 0000260220 00000 n Veins will appear as a dark line. The dorsal venous network is It is also possible to apply multiple tourniquets. If the person is dehydrated or hasnt been drinking a lot of fluids, get them to drink some and see if that helps. As we mentioned, it is your duty as a medical professional to ensure the patient that everything will be ok. Follow your institutional policy when using blood pressure cuffs. Edematous sites (swollen sites filled with serous fluid), From an IV cannula (unless permitted by your institution), Sites above an IV cannula in the same vessel, Arm with a preexisting or current blood clot, Evacuated Collection Tubes (tubes specific to labs ordered), Personal Protective Equipment (ie gloves), Bio-hazard leak-proof transportation bags. Alternate arms if youve given blood recently. instance: "61c9f514f13d4400095de3de", We strive to be the I was in a patients home a few days ago and had to call EMS, the patient was obese and her spouse said she had terrible veins. Go to Alexander Street homepage, Blood Collection: Special Considerations, Obese Patients. Doctors usually mistake if for hyperkalemia when assessing the results. Sometimes, doing so can reveal a vein. A transilluminator is a cool way of finding or confirming veins. Contact should be limited and you shouldnt place the locator on burned skin. 0000000016 00000 n Specializes in Wound Care. After all, you want the experience to be as pleasant for them as possible. All rights reserved. Dont do any heavy lifting or vigorous exercise for the rest of the day. 0000001848 00000 n If the median cubital, cephalic, or basilic veins cant be found, then go to other sites on the arm. They dont harm the patient in any way and can be used regularly to make your job easier and safer. So, get help! Sometimes, the patient may experience hemoconcentration. Spend a decent amount of time looking for good veins. (function() { Although this is something you mightve seen a lot in the movies, you should always avoid it. They need to be labeled in advance. For multiple samples use the luer adapter or a 10 ml syringe. An example of data being processed may be a unique identifier stored in a cookie. Talk to your doctor or therapist about improving your coping skills and consider these tips to cope with obesity and your weight-loss efforts: Journal. Survey the hand and choose a vein that you can draw blood from. It can help veins to pop up, making them probably visible and easier to find. 0000009535 00000 n They should be spread distally from proximal joint to the insertion site. The medical expert needs a certain amount of practice as there are many things that can go wrong. 0000017785 00000 n Eat a healthy meal, avoiding fatty foods like hamburgers, fries or ice cream. 0000028908 00000 n I am a Licensed Phlebotomist and Certified Medical Assistant of 15+ years with 14+ years of clinical experience. When the body is properly hydrated, veins become more dilated. The veins of one patient may be different in size and quality from another. It worries me to see so many people in this thread and others talk about seeing veins and palpating them only if you can't see one. Venous access s 0000012940 00000 n Orange light highlights veins as deep as 3 mm. You need to have a firm, strong grip on patients hand. Nowadays, there is equipment that can help us locate the vein. (Immediate download. Perform good hand hygiene and don appropriate PPE. These other sites should always only be considered when there are no other viable options available to you. ARe there any tips on how to be more successful? The forearm is about the last place to look. The nurse can take the persons blood pressure. Like most medical procedures, phlebotomy can be really easy or really hard. Identify the patient using two patient identifiers as mandated by JCAHO. 1 Article; Avoid snapping or tapping veins. Make sure to perform venipuncture from patients non-dominant arm (which is usually the left one) as it will allow him to use his dominant arm afterwards. Do it by performing a quick backward motion. As a phlebotomist, I have been faced with situations where drawing blood from a person was quite difficult. Follow institutional guidelines and policies wherever applicable. Your veins will be easier to find and palpate when you are well relaxed, as tension can constrict veins. Its important to do everything in your power to ensure the comfort of the patient when drawing blood. Carrington College does not recruit or enroll residents of the European Union. Enjoy :). Then, apply heat to the lowered arm. Ask a friend to donate at the same time . These three together can help you find a vein. Massage the arm. 0000012539 00000 n They are springy and bouncy. That means that you can trust us to have reliable, up-to-date information Approach Considerations. Always avoid drawing blood from areas where the skin is damaged, inflamed, infected or burned. What Does Blood Draw or Venipuncture Training Involve? Has 1 years experience. Perform hand hygiene and don proper PPE. Veins may collapse in the process and failed attempts at blood draws lead to hematomas which bring about pain. It can be done by palpating the vessel or via transillumination with a special light. Then, add massage to the combination. Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. Massaging may help you in finding a vein if you have not already found one. The elderly are prone to bruising when applying the tourniquet. This is especially important for babies and small children that have the natural aversion to needles. This will help force blood up and fills the veins making a vein pop up. In order to reduce the risk of thrombosis, lines need to be flushed with a solution of heap in. Get the patient to lower his or her arm. 11. Quiz and answer key included. Use these tips to reduce the level of difficulty and make your chances more successful. Subscribe for the latest nursing news, offers, education resources and so much more! Blankets or towels from a warmer can also be used. Label appropriate tubes at the bedside and place them into transport bags. Bloating. However, it does BECOME easier with practice. One thing that I find that helps is using two tourniquets - take them together and tie it. Sometimes you can find a good one there, though be careful as you insert the needle. The worst thing you can do is to continue stabbing the patient. Talk about pressure! Dismiss. Excess fat around the waist can put you at an even higher risk for obesity-related health problems, including heart disease and type 2 element: document.getElementById("fbct7c991c3d"), Rotate the wrist while maintaining the position of the arm. You have to palpate first and decide from there. If using wet or damp washcloths, do so with caution. It uses high intensity light that is directed down through the skin. For hospitalized patients, raise the head of the bed. At some time in life, every person will do a blood test, and not only one but multiple as life goes on. This will lead to a better compression that will properly regulate the pressure. Some veins can be deep in the antecubital fossa area, especially, if there is a lot of fat tissue. Make sure you have one in your venipuncture equipment. Become a Part of the Nurse.org Community! window.addEventListener('click-table-loaded', function(){ If the blood is not delivered in a timely manner it can cause hemolysis and skew the lab results. Please enter a valid e-mail address. I once had a patient who was a VERY difficult stick - I brought in the best of the best IV starters that were working that night, but no luck. It is crucial to use needle and cannula that is smaller than the patients vein. 0000180491 00000 n Pump the fists! They will be much easier to spot and throbbing. Sure, its easier said than done when a needle is about to enter a persons vein, but tension can constrict veins. Do not snap your fingers over the vein as doing so can be painful and can initiate clotting activity, resulting in erroneous test results. Similarly to insertion, removal of the needle should also be swift and efficient. In the event that you cant locate the appropriate vein strictly by vision, this can be a great alternative method. WebOnce veins have been located, return the patients arm to the horizontal position for the blood draw. window.ClickTable.mount(options); Over the years I have drawn blood from many older patients, learning tips and techniques along the way in dealing with them and drawing blood from them. Before and after the insertion, the tube should be left in the holder. It is the sharpest part and this will be the best way of insertion. Depending on whether it is for transfusion or simple blood analysis, your cannula size will vary. Contact Us | Work @ Carrington | Privacy Policy | Terms of Service | Do Not Share My Personal Information | Sitemap | Student Consumer Information. Check out our Facebook page and give it a like: http://www.redcrossblood.org/donating-blood/tips-successful-donation. If a vein is not prominent enough to see easily, you can feel around for it. Can You Get an Associate Degree in Nursing Online? Massage the arm from the wrist to the elbow if using arm veins. Obese patients, particularly those considered to be extremely obese, have reported being treated with disrespect by physicians and other medical staff. WebFor routine blood draws, 70% isopropyl alcohol or 70% ethyl alcohol is recommended. 0000010671 00000 n The WHO has best practices that are key to preventing infection and being successful during blood draws. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to. Since 1997, allnurses is trusted by nurses around the globe. Take a look at these tips for drawing blood successfully: Feel & Touch When you receive your initial instruction on how to conduct basic blood draws, your Avoid excessive probing. The ability to obtain blood samples rapidly without altering cells in the sample is essential to maximize diagnostic quality. 3. Keep the strip bandage on for the next several hours; to avoid a skin rash, clean the area around the bandage with soap and water. If a patient is reluctant or fearful, it can interfere with drawing blood. Elderly persons walking in to do blood tests usually have nicer veins, though, there will still be a few difficulties. After that, pressure needs to be applied on insertion point. Ask the individual to elevate his or her arm at the elbow. Find a convenient blood drive near you and schedule an appointment to donate today. Other times, they dont want to pop out or raise for the phlebotomist to be able to draw successfully. 0000009423 00000 n Its important to speak to your supervisor to learn the steps in order to become certified in your hospital. Extend the arm. The information provided should not be used for diagnosing or treating a health problem or disease. Commercial heat-packs are best for this technique as you can choose the temperature you want. We and our partners share information on your use of this website to help improve your experience. Although this is not a necessity, it is pretty much recommended. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. If you really can't see a vein they usually will have one on their hand just between the 4th and 5th finger on the top of the hand. Youll be the first to know about nursing news, trending topics and educational resources. Feel out all your possible options before you decide to go for it. Standard data rates may apply. Doing so can help move veins and tendons away from each other increasing the likelihood for a vein to show up. For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. In certain cases, the patient may move a bit which may result in you sticking the needle in your own finger. But sometimes, it can find a vein you didnt see or feel. Top Cheap and Fast Online RN to BSN Programs, Affordable Online Nurse Practitioner Programs, Top Direct-Entry Nurse Practitioner Programs, Top Psychiatric Nurse Practitioner Programs, Top Pediatric Nurse Practitioner Programs, Top Acute Care Nurse Practitioner Programs, Top Online Family Nurse Practitioner Programs, Top RN to Psychiatric Nurse Practitioner Programs, Top Womens Health Nurse Practitioner Programs, How to Get an Associate Degree in Nursing. Otherwise, it may indicate that you have missed which is when you should immediately back up. When done drawing blood, ask the patient if all is well. Relax for a few minutes in our refreshment & recovery area have some cookies or other snacks youve earned it! 0000016846 00000 n Linkedin, How to Identify a Usable Vein for Blood Draws. Venipuncture is a skill that takes time and practice to master. In situations like these, you have to be patient and apply various techniques depending on the reason for the difficulty. Most of the time, the visibility of the vein depends on the patient. Commercial heat packs are best. However, there are numerous things that can go wrong while you draw blood. Usually, if you cant find a vein in the antecubital fossa or at the back of the hand, you will find one in the forearm. Sometimes, it can still be hard to find the vein after applying the tourniquet. They can be riskier, especially if you need to draw a lot of blood. Make sure not to press too hard! To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail. This is mainly due to the fact that different people have different biological systems which can make it harder to find and puncture the vein. Also, you can gently press the needle against the venipuncture site for several seconds before insertion so that the nerves can get accustomed. But when dealing with a particularly disruptive or difficult individual, its imperative to balance both sympathy and professionalism in this matter. possible. A trick I use sometimes is putting a second tourniquet 2 inches above the first tourniquet. At nurse.org, we believe that no one knows nurses better than, well, nurses. Average delivery time is 5-10 business days. Using alcohol or some other antiseptic, wet the site. 6. Most people have normal looking serum. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. When performing venipuncture, make sure to sit whenever you can. Manage Settings This is the main reason why a lot of tests go array. Every so often I'll go in an area where I'm not sure whether I feel anything or not, but know there's usually a vein there. Rolling up gown sleeves (rather than pushing sleeves up) to enhance tourniquet visibility. Additional equipment such as goggles and splash shields should also be worn in extreme situations. Password must have at least 1 special character(s). Be sure that youre doing everything in your power to keep a level mindset before and during the blood drawing process. Gloves are a must. Red light reaches a depth up to 6 mm. If you donate your blood to organizations like the American Red Cross, then you can rest easy knowing, A phlebotomist is a medical professional whose main job is drawing blood. 196 45 0000014430 00000 n Drink an extra four (8 oz.) Throw everything in proper containers. If no blood flows, pull out the needle and repeat the draw. WebInflate cuff to 30mm Hg above systolic reading and maintain pressure for about 1 to 2 minutes. If the veins are deep and not visibly popping out, use a tourniquet and have the patient lower their arm. Many times combining techniques can mean the difference between finding a vein or not. I had one not too long ago where I had to do a 1 hour glucose tolerance test and was having trouble finding a vein. Only major veins should be used here. link to Blood Test Vs Blood Donation (Comparisons), link to No More Blood Tests For Marriage License. Attach the needed tubes or syringes to remove the proper volume of blood. They are not as healthy and strong as they once were. If at the hospital, get nursing staff to assist you. If youre a phlebotomist who has encountered this problem before, you know how frustrating it can be. That's why we rely on registered nurses and other experienced healthcare 0000025579 00000 n This can be a real time saver and it is also the best way of finding the right insertion point. Do not snap it against the patients skin as doing so could cause bruising in the area.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[468,60],'phlebotomistreport_com-banner-1','ezslot_5',168,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-banner-1-0'); The 3 main areas to find veins include the antecubital fossa, the forearm, and hand veins. It is the best thing for patients with low blood pressure. Insert the needle at a 15 to 30-degree angle into the vessel. The loss of support makes it easy for veins to roll causing difficulty in drawing blood. Instead of forcefully tapping the vein, it is much better if you start stroking them. Patients hand should be dangling so that the blood can rush down and fill the veins. Even with all these guidelines, perhaps the best approach is if you ask the patient from which vein they usually draw his blood. Very often, drinking water will get veins to show up that were not visible or palpable before. It happens! Best practices in phlebotomy involve the following factors: Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. Without further ado, here are 50 tips that will help you perform this crucial procedure. We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. Enjoy :). I'm not sure I understand how this works, as the valves are already in place to prevent backflow. This can help reveal the vein. While doing all of this, make sure to penetrate the skin with one quick move. At some time in life, every person will do a blood test, and not only one but multiple as life goes on. Afterward, you can easily go upwards. If you cant find one, consider the third option, the forearm. After a few minutes, gently tap the site of the puncture with your fingers to make the vein pop out. It allows the phlebotomist to control the vacuum, which is good because it is much less traumatic on a patient's vein. I Feel Stuck - Like My Options Are Limited, Ethical Arguments Against Mandatory Vaccination, Nursing Student on Spring Break Saves Collapsed Man's Life, Candida Auris: Dangerous Fungus Spreading in US Health Care Facilities, Nurses Week 2023 | Best Discounts, Freebies, and More. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. Try light exercise beforehand. The rightvein should feel somewhat bouncy as you press on it. Another technique is for you to use a blood pressure cuff. Check between the knuckles. So, the choice of equipment will change from patient to patient. Properly label the tubes and send to the laboratory for analysis. Get someone to assist if you are not trained or dont have experience. If a person is overweight, it might be harder for a professional to find the vein. The practice of phlebotomy is not something that can strictly be learned from watching videos or reading a how-to guide but something that must be practiced repeatedly in a controlled environment with other trained professionals. Some will come on wheelchairs, using a cane, needing help to walk, move, sit and stand. Some individuals will have far more noticeable veins than others, some will be calm about the procedure and others will require a great deal of calming down, etc. If you are drawing from a leg, the extremity needs to be placed over the bed so that the blood can easily flow into it. 0000185079 00000 n Blood tests are no longer Hi! To use a tourniquet to draw blood correctly, you should tie it three or four inches directly above the puncture site. This causes the veins to engorge and become visible. Let us know if you have a preferred arm or particular vein that has been used successfully in the past to draw blood. If you're drawing blood cultures, be sure to follow the policy and procedure at your facility. I'm having a hard time finding veins then starting IV or drawing blood on obese patients. Make sure you check with the nurse first for permission. If a person doesnt have enough experience, he might make a mistake by not removing the tourniquet before the needle. Afterward, make sure to store them properly. This can help individuals with deep veins, who are obese, or with some edema. Maybe the number one thing that a person can do is to make sure they are well hydrated. Sometimes, you will need another person or two to help you with difficult patients. 2023 Carrington College. There is no easy way to draw blood. Place it at the chin and lightly draw a straight line. For hand veins, apply the tourniquet 1-2 inches above the wrist. antibiotic shot in buttocks pain,

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